Annual Prostate-specific Antigen Screening Research Articles

Prostate-Specific Antigen Screening and Prostate Cancer Mortality: An Emulation of Target Trials in US Medicare.

No consensus about the effectiveness of prostate-specific antigen (PSA) screening exists among clinical guidelines, especially for the elderly. Randomized trials of PSA screening have yielded different results, partly because of variations in adherence, and it is unlikely that new trials will be conducted. Our objective was to estimate the effect of annual PSA screening on prostate cancer (PC) mortality in Medicare beneficiaries age 67-84 years. This is a large-scale, population-based, observational study of two screening strategies: annual PSA screening and no screening. We used data from 537,599 US Medicare (2001-2008) beneficiaries age 67-84 years who had a good life expectancy, no previous PC, and no PSA test in the 2 years before baseline. We estimated the 8-year PC mortality and incidence, treatments for PC, and treatment complications of PSA screening. In men age 67-74 years, the estimated difference in 8-year risk of PC death between PSA screening and no screening was -2.3 (95% CI, -4.1 to -1.1) deaths per 1,000 men (a negative risk difference favors screening). Treatment complications were more frequent under PSA screening than under no screening. In men age 75-84 years, risk difference estimates were closer to zero. Our estimates suggest that under conventional statistical criteria, annual PSA screening for 8 years is highly compatible with reductions of PC mortality from four to one fewer PC deaths per 1,000 screened men age 67-74 years. As with any study using real-world data, the estimates could be affected by residual confounding.

Editors' Selections from Relevant Scientific Publications

Editors' Selections from Relevant Scientific Publications

Association between prostate-specific antigen screening and prostate cancer mortality in a racially diverse cohort of United States veterans.

225 Background: African American (AA) men are known to develop more aggressive forms of prostate cancer at a younger age compared to their Non-Hispanic White (NHW) counterparts. However, few AA men were included in the major randomized trials assessing the efficacy of Prostate-Specific Antigen (PSA) screening. It is thus unknown whether PSA screening may be more beneficial in the AA population. Methods: We conducted a retrospective analysis of men diagnosed with prostate cancer in the United States (US) Veterans Affairs Health System (VA) using the VA Informatics and Computing Infrastructure. Inclusion criteria were AA or NHW men aged 55-69 diagnosed with intermediate or high-risk prostate cancer between 2004 and 2017. Patients were classified as never screened with PSA prior to diagnosis, screened at least once prior to diagnosis (some screening), or screened in 5 consecutive years prior to diagnosis (annual screening). A lead-time bias adjusted multivariate regression model was implemented to assess the effect of screening on prostate cancer specific mortality (PCSM), with covariates including age, comorbidities, BMI, smoking history, marital status and primary care utilization. Results: A total of 45,825 men met the inclusion criteria and were included in the analysis, including 14,294 (31.1%) AA men and 31,151 (68.9%) NHW men. When compared to no screening, any prior PSA screening was associated with improved PCSM for both AA (subdistribution hazard ratio (SHR) 0.64, p < 0.001) and NHW (SHR 0.62, p < 0.001) patients. Annual PSA screening (vs no or some screening) was associated with improved PCSM for AA men (SHR 0.68, p = 0.013) but not NHW men (SHR 0.90, p = 0.240). Other significant predictors of worse PCSM in both AA and NHW men included older age, earlier year of diagnosis, greater comorbidity burden, and cigarette smoking. Conclusions: In a diverse population of US veterans, at least one prior screening PSA was associated with improved PCSM in both AA and NHW patients. Annual PSA screening was associated with reduced PCSM in AA but not NHW men, suggesting that more intensive screening protocols may be beneficial for AA patients.

Predictors of annual prostate-specific antigen (PSA) screening among black men: results from an urban community-based prostate cancer screening program.

Black men have an increased risk of prostate cancer mortality compared with any racial or ethnic group. Further, research on prostate cancer prevention and control messaging focusing on Black men is limited. Community screening events are successful in attracting members from high-risk groups, like Black men, and are a valuable source to collect cancer screening and health promotion data. Therefore, the authors examined data of Black men attending a community-based PCa screening event to evaluate predictors of annual PCa screening, and identify sub-populations of Black men needing targeted cancer prevention messaging. Black men attending PCa screening events in St. Louis, MO 2007-2017 were eligible. Participants completed either a mail-in or on-site survey at the time of their screening to collect information on annual screening history. We analyzed sociodemographic factors, having a first-degree relative with a history of PCa, healthcare utilization characteristics, and predictors of annual PSA screening. Logistic regression analysis was used to assess the association between predictors and annual PSA screening. Data was analyzed from 447 respondents. One-third of the residents did not know their cancer family history status. Older age and having a primary healthcare provider predicted an annual prostate cancer after attending the PCa community screening event. In the fully adjusted model, all ages older than 45 years were 2-4 times more likely to have an annual PCa screening. Having a healthcare provider also predicted an annual PCa screening (OR: 4.59, 95% CI: 2.30-9.14). Regardless of sociodemographic and family history factors, older Black men and those with a primary physician are more likely to have an annual PSA screening. Cancer prevention promotion efforts for Black men should target mechanisms that facilitate family cancer history conversations to engage younger Black men. Also, additional health promotions efforts are needed to educate Black men without a primary healthcare provider.

PD38-01 VALIDITY OF PSA SCREENING TRIALS IN A 'REAL WORLD' SETTING: A NATIONWIDE SURVEY ANALYSIS

You have accessJournal of UrologyProstate Cancer: Detection & Screening III (PD38)1 Apr 2020PD38-01 VALIDITY OF PSA SCREENING TRIALS IN A 'REAL WORLD' SETTING: A NATIONWIDE SURVEY ANALYSIS Deepansh Dalela*, Akshay Sood, Jacob Keeley, Sohrab Arora, Marcus Jamil, Chandler Bronkema, Nikola Rakic, James Peabody, Craig Rogers, Quoc-Dien Trinh, Mani Menon, and Firas Abdollah Deepansh Dalela*Deepansh Dalela* More articles by this author , Akshay SoodAkshay Sood More articles by this author , Jacob KeeleyJacob Keeley More articles by this author , Sohrab AroraSohrab Arora More articles by this author , Marcus JamilMarcus Jamil More articles by this author , Chandler BronkemaChandler Bronkema More articles by this author , Nikola RakicNikola Rakic More articles by this author , James PeabodyJames Peabody More articles by this author , Craig RogersCraig Rogers More articles by this author , Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author , Mani MenonMani Menon More articles by this author , and Firas AbdollahFiras Abdollah More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000917.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The efficacy of prostate specific antigen (PSA) screening is predicated on, amongst other factors, age and ethnicity of recipients. The goal of the current study was to compare the age and ethnicity of men undergoing PSA screening the United States (US) to those represented in the Prostate, Lung, Colorectal and Ovarian cancer (PLCO) and the European Randomized Study of Screening for Prostate Cancer (ERSPC) trials. Such a comparison is a key to assess the external validity of these trials in the “real world” setting. METHODS: We used publicly-available data from National Health Institution Survey (NHIS) 2000-2018, the world’s oldest continuously administered survey of non-institutionalized US population. Men aged 50-74 without prior history of prostate cancer (PCa) who underwent PSA testing in the last 12 months as a part of routine test were considered to have undergone PSA screening. Age at PSA screening and self-reported ethnicity were compared with results reported in the PLCO (Andriole, NEJM 2009) and ERSPC (Schroeder, NEJM 2009) trials, using Rao-Scott Chi-Square tests. RESULTS: Overall, 10,854 (weighted n=11,257,531) men underwent annual PSA screening within the available years. The median (IQR) age for PSA screening recipients was 60.9 (55.3-66.4) years (compared to 61.7 years in ERSPC). While PLCO did not report the median age of their cohort, they reported the percentages in each age category. Interestingly, 59.2% of men were aged 60-74 in our cohort vs 68% in PLCO cohort (p<0.001). In terms of ethnicity, 1276 (weighted n=976,126; 8.7%) men in our dataset were African-American, compared to 4.4% in PLCO (p<0.001). CONCLUSIONS: Our analyses shows that compared to PLCO, US men undergoing PSA screening over the last two decades were younger and twice as likely to be African-American. Interestingly, the age distribution in NHIS was similar to men in the ERSPC study (that showed mortality benefit with PSA screening). As such, results of PLCO study may not be extrapolatable to US men, and our findings should be kept in mind when counseling men about the potential risks vs benefits of PSA screening. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e801-e801 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Deepansh Dalela* More articles by this author Akshay Sood More articles by this author Jacob Keeley More articles by this author Sohrab Arora More articles by this author Marcus Jamil More articles by this author Chandler Bronkema More articles by this author Nikola Rakic More articles by this author James Peabody More articles by this author Craig Rogers More articles by this author Quoc-Dien Trinh More articles by this author Mani Menon More articles by this author Firas Abdollah More articles by this author Expand All Advertisement PDF downloadLoading ...

Prevalence and Predictors of Routine Prostate-specific Antigen Screening in Medicare Beneficiaries in the USA: Retrospective Cohort Analysis Using Machine Learning

Objective: To estimate the prevalence and predictors of Prostate-Specific Antigen (PSA) screening among Medicare beneficiary men using machine learning algorithms. Methods: A retrospective cohort analysis used the Medicare Current Beneficiary Survey Public Use File (MCBS PUF) data from 2015 and 2016. Predictors of PSA screening were examined through multivariable logistic regression and machine learning techniques. Results: Over half (56%) of Medicare beneficiary men had PSA screening during 2015-2016. Ages between 65 and 75 years, education above high school, being married, higher annual income (&gt;$25,000), being overweight or obese, and more than 20 outpatient office visits were significant predictors. Conclusion: PSA screening uptake was 56 percent among Medicare beneficiaries and it was driven by beneficiaries’ age, education, marital status, income, body mass index, and number of outpatient visits. Although Medicare provides free annual PSA screening, uptake was higher among high-income beneficiaries. Awareness strategies would help inform privileges for PSA screening under Medicare and the advantages of routine screening for mitigating the health risks.

357 Prostate-Specific Antigen (PSA) Screening Rates in the United States, 2009–2015: Implications for Practice Interventions

Prostate-specific antigen (PSA) is the most commonly used cancer screening test in men. Currently, there are two sets of recommendations for PSA screening: one championed by the US Preventive Services Task Force against screening of men of all ages, and the other by the American Cancer Society for offering screening only to 50- to 69-year-old men after informed/shared decision making. We evaluated PSA screening rates from 2009 through 2015. Claims for PSA screening of asymptomatic men, done by excluding PSA testing associated with 62 prostate or urinary conditions, were collected using Medicare (17.7–21.8 million men >64 years old) and MarketScan (9.9–16.5 million men 30–64 years old) databases. Trend tests were performed using a two-sided Poisson regression with Bonferroni correction. Annual PSA screening rates were 2% in men aged 30–39, 13%-14% in men aged 40–49, 29%-31% in men aged 50–59, 33%-36% in men aged 60–64, 9%-13% in men aged 65–69, 11%-15% in men aged 70–74, and 9%-13% in men aged ≥75 years. Downward temporal trends were significant for ages 60–64 years (P = .002) and 70–74 years (P = .004). The 2009 to 2015 change in screening rate ranged from a decrease of 16% in men aged 70–74 years to an increase of 2% in men aged 30–39 years. Overall, PSA screening has decreased. Despite all recommendations against screening men aged <50 and >69, PSA screening is still performed in these age groups. In the >49 age group, PSA screening rate decreased presumably due to combined influence of all recommendations. There is a need to further understand why consensus recommendations for screening of men <50 and >69 are not fully followed. These results might also suggest continued opportunities for laboratory professionals to work with clinicians to implement only evidenced-based laboratory screening recommendations.

Let's Not Throw the Baby out With the Bathwater in Prostate Cancer Screening

In 2012, the United States Preventive Services Task Force recommended against prostate-specific antigen (PSA) –based screening for prostate cancer (grade D recommendation) primarily on the basis of the results of two large randomized clinical trials: the US Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial and the European Randomized Study of Screening for Prostate Cancer (ERSPC). In the article accompanying this editorial, Shoag et al present their analysis of questionnaire data sent to a subset of participants in the prostate component of the PLCO study. They again illustrate the high contamination rate in the control arm of the study and call into question the internal validity of PLCO and, ultimately, whether the negative study finding can be used to inform the discussion around the effectiveness of PSA-based screening. The United States Preventive Services Task Force is currently in the process of updating their recommendation concerning PSA-based screening. Given the data presented by Shoag et al, the panel will have to seriously reconsider the validity of the PLCO trial in their deliberations. However, even if they were to completely discount PLCO, it is not entirely clear that the magnitude of benefit currently seen in the ERSPC trial will be enough to support a change in the recommendation. The latest report from ERSPC indicates that, with 13-year follow-up, 27 cases of prostate cancer need to be detected (NND) to prevent one prostate cancer–related death (NND). Although modeling studies extrapolating follow-up in ERSPC out to 25 years or more indicate that NND ultimately may be less than 10, these simulation studies are dependent on myriad assumptions, which may or may not prove to be true. To this end, the task force may choose to only consider the actual randomized clinical trial evidence collected from ERSPC to date, which currently indicates a small to moderate benefit at best. The documented (albeit small) benefit of PSA screening identified in ERSPC must then be weighed against the potential harms of screening. For example, an elevated PSA test often leads to a prostate biopsy. In a recent study of 1,147 men undergoing prostate biopsy in the Prostate Testing for Cancer and Treatment study, 31.8% reported grade 2 adverse events (defined as symptoms causing moderate/major problems or requiring contact with the health care system) and 1.4% required hospital admission within 30 days. Although no deaths were noted in the cohort, these adverse events undoubtedly resulted in discomfort and anxiety, with at least a temporary negative impact on overall health. Furthermore, in patients in whom prostate cancer is diagnosed and treated, both surgery and radiation are associated with a considerable risk of sexual, urinary, or bowel problems. This may be acceptable in patients with higher-risk disease, who are likely to experience a survival benefit from aggressive treatment. Given the widely recognized risk of overdiagnosis associated with population-based annual PSA screening, patients diagnosed with low-risk clinically indolent disease who elect aggressive therapy are unlikely to garner any survival advantage and are, therefore, at considerable risk of overtreatment. Recent data demonstrating increased use of active surveillance in American men diagnosed with low-risk disease is reassuring, however, as we attempt to optimize the balance of predicted benefit associated with prostate cancer treatment and the predicted morbidity of therapy. Increasing penetration of active surveillance will likely mitigate some of the risk of overtreatment, but, given ongoing challenges associated with accurately classifying indolent and clinically relevant disease, it certainly does not eliminate it. If one weighs the benefits of population-based screening seen in ERSPC (completely dismissing PLCO) against the potential harms noted in these and other studies, it is not completely unreasonable to conclude that the benefits of population-wide annual PSA screening do not outweigh the harms. Does this mean that we should abandon PSA-based screening altogether? Given the benefit seen in ERSPC, the answer is clearly no. Rather, we should focus on identifying better screening strategies that optimize the risk-benefit ratio by personalizing the approach to the target population’s underlying risk of disease. Consider that the ERSPC consisted of eight unique sites that used eight similar but distinct protocols for prostate cancer screening that varied by age of initiation, screening interval, and threshold for diagnostic biopsy. Of these eight sites, only two (Sweden and the Netherlands) noted a statistically significant difference in prostate cancer–specific survival, although the magnitude of observed differences and the size of these cohorts were sufficient to drive the results of the parent study. The observed heterogeneity in outcomes between ERSPC sites is likely the result of variation in the intensity and delivery of the intervention (PSA screening) superimposed on differences in underlying risk of disease between

Prostate cancer screening in Primary Health Care: the current state of affairs.

This study aims to examine the current practice of General practitioners (GPs)/primary care physicians in opportunistic screening for prostate cancer (PC) by digital rectal examination(DRE) and Prostate Specific Antigen(PSA) testing and identify any difference in screening practice.Printed copies and/or electronic versions of a survey was distributed amongst 438 GPs throughout Australia in 2012. Statistical analyses (Wilcoxon rank-sum test, Fisher’s exact test or Pearson chi-square test)were performed by outcomes and GP characteristics.There were a total of 149 responses received (34%), with similar gender distribution in rural and metropolitan settings. 74% GPs believed PSA testing was at least ‘somewhat effective’ in reducing PC mortality with annual PSA screening being conducted by more GPs in the metropolitan setting compared to the rural GPs (35% vs 18.4%), while 25% of rural GPs would not advocate routine PSA screening. When examining the concordance between DRE and PSA testing by gender of GP, the male GPs reported performing PSA testing more frequently than DRE in patients between ages 40 to 69 (p = 0.011).Urology Society guidelines (77.2%) and College of GPs (73.2%) recommendations for PC screening were thought to be at least ‘somewhat useful’. Although reference ranges for PSA tests were felt to be useful, the majority (65.8%) found it easier to refer to an urologist due to the disagreements in guidelines.In conclusion, the current guidelines for PSA screening appear to cause more confusion due to their conflicting advice, leaving GPs to formulate their own practice methods, calling for an urgent need for uniform collaborative guidelines.Electronic supplementary materialThe online version of this article (doi:10.1186/s40064-015-0819-8) contains supplementary material, which is available to authorized users.

Association of Healthcare Barriers With Prostate-specific Antigen Screening Among African-American and Afro-Caribbean Men

To evaluate the association between the barriers to healthcare access and prostate-specific antigen (PSA) screening practices among African-American and Afro-Caribbean men. Stratified cluster sampling of census tracts in Brooklyn, New York yielded 533 men, aged 45-70 years. The men were classified into the following groups: U.S.-born white, U.S.-born African-American, Jamaican, and Trinidadian/Tobagonian. The subjects completed a written 6-item survey assessing the healthcare barriers. Overall, 27% of men reported never having had a PSA test and 28% reported that they had received annual PSA screening. On multivariate analysis, those who viewed the healthcare system as convenient were more likely to report an initial PSA test (odds ratio 1.8, P < .05). Those who perceived difficulty in accessing reliable care were less likely to ever have had a PSA test (odds ratio 0.6, P < .05). Subjects who had not had a comprehensive discussion with their physician about prostate cancer were less likely to have had an initial PSA test and more likely to have maintained annual PSA screening (odds ratio 0.3 and 1.7, respectively, P < .05). We identified 2 novel perceived barriers to prostate cancer screening: men who experience the healthcare system as inconvenient were less likely to initiate PSA testing, and those who found it difficult to obtain quality care were less likely to ever have had a PSA test. The perceived system barriers were more closely linked to PSA screening behavior than were the measures assessing perceptions of self-efficacy. Our results suggest that a broader discussion by physicians that addresses the perceptions regarding the healthcare system might enhance the understanding of, and increase the use of, prostate cancer screening among higher risk minority men.

Serum Prostate-Specific Antigen for the Early Detection of Prostate Cancer: Always, Never, or Only Sometimes?

Serum Prostate-Specific Antigen for the Early Detection of Prostate Cancer: Always, Never, or Only Sometimes?

Effect of Dutasteride on Prostate Biopsy Rates and the Diagnosis of Prostate Cancer in Men with Lower Urinary Tract Symptoms and Enlarged Prostates in the Combination of Avodart and Tamsulosin Trial

BackgroundA 23% relative risk reduction (RRR) in prostate cancer (PCa) was shown in men receiving dutasteride in the 4-yr Reduction by Dutasteride of Prostate Cancer Events study, in whom biopsies were protocol dependent. ObjectiveOur aim was to explore PCa risk reduction in men with benign prostatic hyperplasia (BPH) from the Combination of Avodart and Tamsulosin (CombAT) study, in which biopsies were undertaken for cause. Design, setting, and participantsCombAT was a 4-yr randomized double-blind parallel group study in 4844 men ≥50 yr of age with clinically diagnosed moderate to severe BPH, International Prostate Symptom Score ≥12, prostate volume ≥30ml, and serum prostate-specific antigen (PSA) 1.5–10 ng/ml. Men underwent annual PSA measurement and digital rectal examination (DRE), and prostate biopsies were performed for cause. InterventionAll patients took tamsulosin 0.4mg/d, dutasteride 0.5mg/d, or a combination of both. MeasurementsThe primary end point was incidence of PCa. Secondary end points included postbaseline prostate biopsy rates and Gleason score of cancers. Results and limitationsDutasteride (alone or in combination with tamsulosin) was associated with a 40% RRR of PCa diagnosis compared with tamsulosin monotherapy (95% confidence interval, 16–57%; p=0.002) and a 40% reduction in the likelihood of biopsy. There were similar reductions in low- and high-grade Gleason score cancers. The biopsy rate in the groups receiving dutasteride trended toward a higher diagnostic yield (combination: 29%, dutasteride: 28%, tamsulosin: 24%). One limitation was the lack of a standardized approach to PCa diagnosis and grading. ConclusionsDutasteride, alone or in combination with tamsulosin, significantly reduced the relative risk of PCa diagnosis in men with BPH undergoing annual DRE and PSA screening. Consistent with the increased usefulness of PSA for PCa detection, men receiving dutasteride had a numerically lower biopsy rate and higher yield of PCa on biopsy. Trial registrationClinicaltrials.gov identifier: NCT00090103 (http://www.clinicaltrials.gov/ct2/show/NCT00090103).

A Model of Prostate-Specific Antigen Screening Outcomes for Low- to High-Risk Men

Information is needed to aid individual decision making about prostate-specific antigen (PSA) screening. We aimed to provide such information for men aged 40, 50, 60, and 70 years at low, moderate, and high risk for prostate cancer. A Markov model compared patients with vs without annual PSA screening using a 20% relative risk (RR) reduction (RR = 0.8) in prostate cancer mortality as a best-case scenario. The model estimated numbers of biopsies, prostate cancers, and deaths from prostate cancer per 1000 men over 10 years and cumulated to age 85 years. Benefits and harms vary substantially with age and familial risk. Using 60-year-old men with low risk as an example, of 1000 men screened annually, we estimate that 115 men will undergo biopsy triggered by an abnormal PSA screen result and that 53 men will be diagnosed as having prostate cancer over 10 years compared with 23 men diagnosed as having prostate cancer among 1000 unscreened men. Among screened men, 3.5 will die of prostate cancer over 10 years compared with 4.4 deaths in unscreened men. For 1000 men screened from 40 to 69 years of age, there will be 27.9 prostate cancer deaths and 639.5 deaths overall by age 85 years compared with 29.9 prostate cancer deaths and 640.4 deaths overall in unscreened men. Higher-risk men have more prostate cancer deaths averted but also more prostate cancers diagnosed and related harms. Men should be informed of the likely benefits and harms of PSA screening. These estimates can be used to support individual decision making.

Serum Prostate-Specific Antigen Hemodilution Among Obese Men Undergoing Screening in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial

Previous studies have shown an inverse relationship between prostate-specific antigen (PSA) concentration and body mass index (BMI). It has been recently proposed that this relationship may be explained by the larger plasma volume of obese men diluting a fixed amount of PSA (hemodilution effect). We examined this hypothesis in a cohort of men enrolled in the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. Of 38,349 men ages 55 to 74 years randomized in PLCO to receive annual PSA and digital rectal examination screening, 28,380 had a baseline PSA, complete demographic information, and no prostate cancer diagnosis within 6 years from baseline. Self-reported height and weight were used to calculate BMI and to estimate plasma volume. PSA mass was estimated as PSA concentration times plasma volume. Multivariable linear regression models were used to investigate the relationship between PSA concentration, plasma volume, PSA mass, and BMI. PSA concentration significantly decreased with increasing BMI (P<0.001); mean PSA values were 1.27, 1.25, 1.18, and 1.07 ng/mL among normal (BMI, 18.5-25), overweight (BMI, 25-30), obese (BMI, 30-35), and morbidly obese (BMI, >35) men, respectively. However, plasma volume also increased with increasing BMI and PSA mass showed no association with BMI, with mean values of 3.78, 3.95, 3.97, and 3.82 microg across the four BMI categories (P=0.10). This study confirms earlier findings that the inverse relationship between PSA concentration and BMI may be explained by a hemodilution effect. These findings could have implications for prostate cancer screening in large men.

Use of 5-α-Reductase Inhibitors for Prostate Cancer Chemoprevention: American Society of Clinical Oncology/American Urological Association 2008 Clinical Practice Guideline

PURPOSE To develop an evidence-based guideline on the use of 5-alpha-reductase inhibitors (5-ARIs) for prostate cancer chemoprevention. METHODS The American Society of Clinical Oncology (ASCO) Health Services Committee (HSC), ASCO Cancer Prevention Committee, and the American Urological Association Practice Guidelines Committee jointly convened a Panel of experts, who used the results from a systematic review of the literature to develop evidence-based recommendations on the use of 5-ARIs for prostate cancer chemoprevention. Results The systematic review completed for this guideline identified 15 randomized clinical trials that met the inclusion criteria, nine of which reported prostate cancer period prevalence. CONCLUSION Asymptomatic men with a prostate-specific antigen (PSA) <or= 3.0 ng/mL who are regularly screened with PSA or are anticipating undergoing annual PSA screening for early detection of prostate cancer may benefit from a discussion of both the benefits of 5-ARIs for 7 years for the prevention of prostate cancer and the potential risks (including the possibility of high-grade prostate cancer). Men who are taking 5-ARIs for benign conditions such as lower urinary tract [obstructive] symptoms (LUTS) may benefit from a similar discussion, understanding that the improvement of LUTS relief should be weighed with the potential risks of high-grade prostate cancer from 5-ARIs (although the majority of the Panel members judged the latter risk to be unlikely). A reduction of approximately 50% in PSA by 12 months is expected in men taking a 5-ARI; however, because these changes in PSA may vary across men, and within individual men over time, the Panel cannot recommend a specific cut point to trigger a biopsy for men taking a 5-ARI. No specific cut point or change in PSA has been prospectively validated in men taking a 5-ARI.

Prostate cancer screening behaviour

Prostate cancer remains the most common non-cutaneous malignancy, and it is diagnosed by measurement of prostatespecific antigen (PSA), digital rectal examination (DRE), transrectal ultrasound and biopsies. Routine screening with measurement of PSA cannot be justified until long-term randomized studies demonstrate that PSA screening has a significant impact on morbidity and mortality.1 Hopefully, the results of the European Randomized Screening for Prostate Cancer Study among 190,000 men and of the Prostate, Lung, Colorectal and Ovary Screening Study of the US National Cancer Institute upon 74,000 Americans will be available for discussion in 2008.1 Furthermore, PSA screening may result in false-positive cases and diagnosis of clinically insignificant (non-life-threatening) cancers, while there is absence of definitive biopsy results. The controversy regarding routine screening reflects the uncertainty about treating all prostate cancer cases in terms of survival and quality of life. Last but not least is the public health issue of funding for prevention. The American Cancer Society guidelines suggest that men over the age of 50 years should be offered annual DRE and PSA screening (45 years for African Americans and those with a positive family history) as long as they are informed of the benefits and limitations of screening and have a life expectancy of at least 10 years.3 In the UK, the National Screening Committee has introduced a PSA informed choice programme entitled ‘Prostate Cancer Risk Management Programme’. The objective of this programme is to ensure that men receive clear and balanced information about the PSA screening test, and relevant information packs have been sent to general practitioners (GPs) to assist them with screening counselling. However, evidence is scarce regarding the psychological

Barriers to the Initiation and Maintenance of Prostate Specific Antigen Screening in Black American and Afro-Caribbean Men

Black American and Afro-Caribbean men may experience the highest incidence of prostate cancer globally. We examined the effect of race/ethnicity on the initiation and maintenance of annual prostate specific antigen screening and the role of physicians in screening continuity in these high risk groups. Stratified cluster sampling of census tract blocks in Brooklyn, New York yielded 533 male participants 45 to 70 years old. The men were classified into 4 racial/ethnic groups, including white men born in the United States, black men born in the United States, immigrant Jamaican men, and immigrant men from Trinidad and Tobago. Participants recorded the number of prostate specific antigen tests performed in the last 10 years. Subject adherence was calculated as annually screened, less than annually screened and never screened. Multinomial logistic regression was used to compare screening behavior across the ethnic groups. Overall 28.3% of participants reported annual screening, 44.5% reported screening less than annually and 27.2% reported having never been screened. Jamaicans (OR 3.1) and men from Trinidad and Tobago (OR 5.4) were more likely to screen less than annually compared to not at all. However, black American men (OR 0.3), Jamaican men (OR 0.3), and men from Trinidad and Tobago (OR 0.2) were less likely to maintain annual screening compared with white men, as were men who did not undergo an annual physical examination (OR 0.3) and those with low prostate cancer knowledge (0.5). Afro-Caribbean men are not less likely than white men to undergo initial prostate specific antigen screening but they are much less likely to maintain annual screening. Through comprehensive discussion and annual examinations physicians have an important role in ensuring prostate specific antigen screening continuity. Our results suggest the need for more culturally appropriate outreach efforts and educational interventions to improve screening compliance.

The case for prostate‐specific antigen screening starting at age 40

The case for prostate‐specific antigen screening starting at age 40

Annual PSA Screening Is Unnecessary in Some Men

The idea of a yearly interval for prostate-specific antigen (PSA) screening derives from the old habit of performing screening tests annually. However,

SERIAL PROSTATE SPECIFIC ANTIGEN SCREENING FOR PROSTATE CANCER: A COMPUTER MODEL EVALUATES COMPETING STRATEGIES

Purpose We compare prostate specific antigen (PSA) screening strategies in terms of expected years of life saved with screening, number of screens, number of false-positive screens and rates of over diagnosis, defined as detection by PSA screening of patients who would never have been diagnosed without screening. Materials and Methods A computer model of disease progression, clinical diagnosis, PSA growth and PSA screening was used. Under baseline conditions, when screening is not considered, the model replicates clinical diagnosis and disease mortality rates recorded by the Surveillance, Epidemiology and End Results Program of the National Cancer Institute in the mid 1980s. Results Biannual screening with PSA greater than 4.0 ng./ml. was projected to reduce the number of screens and false-positive tests by almost 50% relative to annual screening while retaining 93% of years of life saved. With annual screening use of an age specific bound for PSA to consider a test positive instead of the standard 4.0 ng./ml. was projected to reduce false-positive screens by 27% and over diagnosis by a third while retaining almost 95% of years of life saved. Sensitivity analyses did not change the relative efficacy of biannual screening. Conclusions Under the model assumptions biannual PSA screening is a cost-effective alternative to annual PSA screening for prostate cancer. With annual screening use of an age specific bound for PSA positivity appears to reduce false-positive results and over diagnosis rates sharply relative to a bound of 4 ng./ml. while retaining most of the survival benefits.